Table 3 Summary of focus group results for the McDowell CHOICES program

1. General interest in PA is high and participation in the few available programs is usually good.

1. General interest in PA is high among children, adolescents and adults.

2. School infrastructure/facilities.

2. School facilities.

3. Several outside spaces and county and state parks.

1. Widespread sedentary lifestyle of children.

1. Poor condition of existing outside spaces and parks.

2. Lack of access to proximal PA resources.

2. Geographical size of McDowell County relative to number of inhabitants.

3. Multigenerational families (grandparents and great grandparents raising children).

3. Long travel time.

4. Poor promotion of existing PA opportunities.

4. Lack of appropriate, safe and accessible facilities for PA.

5. Lack of suitable platforms for communication.

5. General narrow view and sheltered perspective of PA possibilities.

6. Absence of suitable indoor facilities for the winter months.

1. Citizens generally open to PA opportunities, especially around the schools.

1. People generally open towards new PA opportunities.

2. Conversion/renovation of existing school facilities.

2. A web-based platform with coordinated information of PA opportunities.

3. Shared use agreements for the use of school PA facilities for students and families.

3. Several smaller scale PA rather than centralized larger ones.

4. Community fitness centers.

4. Renovation of existing facilities a sensible starting point.

5. Need to train local people.

1. Poverty.

1. Poverty.

2. Locality/distrust of outsiders.

2. Multigenerational/aging families.

3. Multigenerational/aging families.

3. Prevalent drug use/abuse, especially with prescription drugs.

4. Poor condition and rampant vandalism of existing infrastructure/facilities.

4. High unemployment rate.

5. Prevalent drug use/abuse

5. Geographic isolation.

6. Poor road condition.

6. Poor travel/road conditions.

7. Social capital/suitable professionals to step up and run new PA programs.